Behavioral Health Flashcards
> 1 manic or mixed episode which often cycles with occasional depressive episodes (but major depressive episodes are not required for diagnosis)
Bipolar I Disorder
Strongest risk factor for bipolar I disorder
Family history (1st degree relatives)
Average age of onset for bipolar I disorder
20s-30s
Abnormal and persistently elevated, expansive or irritable mood at least 1 week (or less if hospitalization is required) with marked impairment of social/occupational function
Mania
Management of bipolar disorder
- Lithium first line
- Valproic acid, carbamazepine
- Haloperidol or Benzos if psychosis or agitation develops
- Therapy
> 1 hypomanic episode + > 1 major depressive episode. mania or mixed episodes are absent
Bipolar II disorder
Symptoms similar to manic symptoms - period of elevated, expansive, or irritable mood at least 4 days that is clearly different from the usual nondepressed mood but does not cause marked impairment, no psychotic features and does not require hospitalization
Hypomania
Management of bipolar II disorder
Acute mania - lithium, valproate
Depression - lithium, valproate, carbamazepine
Mixed - atypical antipsychotics, valproate
> 1 delusion lasting > 1 month without other psychotic symptoms. Apart from delusion, behavior is not obviously odd or bizarre and there is no significant impairment of function. Not explained by another disorder
Delusional Disorder
> 1 psychotic symptom with onset and remission < 1 month
Brief psychotic disorder
Meets criteria for schizophrenia but < 6 months duration
Schizophreniform disorder
Schizophrenia + mood disturbance (major depressive or manic episode)
Schizoaffective disorder
> 6 months duration of illness with 1 month of acute symptoms along with functional decline
Schizophrenia
Risk factors for schizophrenia
Family history
Management for schizophrenia
- Hospitalization for acute psychotic episodes
- 1st line: risperidone, olanzapine, quetiapine
- Clozapine in refractory cases
- Haloperidol, Chlorpromazine
Risk factors for depressive disorders
Family history
Female (2:1)
Highest incidence 20s-40s
Depressed mood or anhedonia or loss of interest in activities with > 5 associated symptoms almost every day for at least 2 weeks
Major depressive disorder
The presence of depressive symptoms at the same time each year (most common in winter)
Seasonal Affective Disorder/Seasonal Pattern
Management of seasonal affective disorder/seasonal pattern
SSRIs
Light therapy
Bupropion
Shares many of the typical symptoms of MDD but patients experience mood reactivity (improved mood in response to positive events). Sx include significant weight gain/appetite increase, hypersomnia
Atypical depression
Treatment of atypical depression
MAO inhibitors
Characterized by anhedonia (inability to find pleasure in things), lack of mood reactivity, depression, severe weight loss/loss of appetite, excessive guilt, psychomotor agitation or retardation and sleep disturbance
Melancholia
Motor immobility, stupor and extreme withdrawal
Catatonic Depression
Screening for depression
PHQ-2 for initial screen
If positive, use PHQ-9
Management of major depressive disorder
- Principal therapy: psychotherapy - CBT, support groups
- SSRIs, SNRIs
- Bupropion and Mirtazapine
- ECT
Excessive anxiety or worry for a majority of days > 6 month period about various aspects of life
Generalized Anxiety Disorder
Management of generalized anxiety disorder
- SSRIs, SNRIs
- Buspirone
- Benzos, beta blockers, TCAs
- Psychotherapy: CBT
Persistent (> 6 mo) intense fear of social or performance situations in which the person is exposed to the scrutiny of others for fear of embarrassment (ex. public speaking, meeting new people, eating/drinking in front of people)
Social anxiety disorder
Management of social anxiety disorder
- SSRIs, SNRIs
- Beta blockers
- Benzos
- Psychotherapy
Recurrent, unexpected panic attacks (at least 2 attacks) may or may not be related to a trigger. Usually sudden in onset, peaks within 10 minutes and usually lasts < 60 minutes
Panic disorder
Anxiety about being in places or situations from which escape may be difficult (open spaces, enclosed spaces, crowds, public transportation)
Agoraphobia
Management of panic disorder
- SSRIs, SNRIs
- CBT
Acute attack - benzo
Management of PTSD
- SSRIs
- MAO inhibitors
- Trazodone for insomnia
- CBT
Management of tobacco dependence
- CBT
- Nicotine gum, nasal sprays, transdermal patches, inhaler, lozenges
- Bupropion
- Varenicline (Chantix)
Physical exam findings for opioid abuse
- Pupillary restriction
- Respiratory depression
- Biot’s breathing
- Bradycardia
- Hypotension
Groups of quick, shallow inspirations followed by regular or irregular periods of apnea
Biot’s Breathing
Seen with opioid abuse
Symptoms of opioid withdrawal
Goosebumps (piloerections)
Pupil dilation
Flu-like symptoms
N/V
Management of acute intoxication of opioid
Naloxone (Narcan)
Management of opioid withdrawal
Clonidine
Methadone tapering
Buphrenorphine + Naloxone
Benzos may be helpful
Signs/symptoms of alcohol withdrawal
- Increased CNS activity - anxiety, tremors, diaphoresis, palpitations
- Withdrawal seizures
- Hallucinosis
- Delirium tremens
Management of alcohol withdrawal
- Requires hospitalization - can be fatal
- IV benzos
- IV thiamine and magnesium (prior to glucose admin)
Medication that can be used as a deterrent to alcohol abuse
Disulfiram
Strongest single predictive factor of suicide
Previous attempt or threat
